Economic studies on health-related issues have the potential to benefit all Americans. The approaches for dealing with the growth of health care costs and health insurance coverage are ever changing and information is needed on their efficacy. Research on health-related topics has been conducted for about a decade at the Census Bureau\u2019s Center for Economic Studies and the Research Data Centers. This paper begins by describing the confidential business and demographic Census Bureau data products used in this research. The discussion continues with summaries of nearly 30 papers, including how this work has benefited the Census Bureau and its research findings. Some focus on data linkages and assessing data quality, while others address important questions in the employer, public, and individual insurance markets. This research could not have been accomplished with public-use data. The newly available data from the Agency for Healthcare Research and Quality and National Center for Health Statistics, as well as additional Census Bureau data now available in the Research Data Centers are also discussed.
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Using the MEPS-IC to Study Retiree Health Insurance
April 2006
Working Paper Number:
CES-06-13
This paper discusses using the restricted-access Medical Expenditure Panel Survey- Insurance Component (MEPS-IC) to study employer-sponsored retiree health insurance (RHI). This topic is particularly interesting given current events such as the aging of baby boomers, rising health care costs, new prescription drug coverage under Medicare, and changes in accounting standards for reporting liabilities related to RHI offerings. Consequently, employers are grappling with an aging workforce, evaluating Medicare subsidies to employers for offering retiree drug plans, facing rising premium costs as a result of rising health care costs, and trying to show profitability on financial reports. This paper provides technical information on using the MEPS-IC to study RHI and points out data issues with some of the measures in the database. Descriptive statistics are provided to illustrate the types of retiree estimates possible using the MEPS-IC and to show some of the trends in this subject area. Not surprising, these estimates show that employer offers of RHI have declined, greater numbers of retirees are enrolling in these plans, and expenditures for employer-sponsored RHI have been rising.
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Declines in Employer Sponsored Coverage Between 2000 and 2008: Offers, Take-Up, Premium Contributions, and Dependent Options
September 2010
Working Paper Number:
CES-10-23
Even before the current economic downturn, rates of employer-sponsored insurance (ESI) declined substantially, falling six percentage points between 2000 and 2008 for nonelderly Americans. During a previously documented decline in ESI, from 1987 to 1996, the fall was found to be the result of a reduction in enrollment or 'take-up' of offered coverage and not a decline in employer offer/eligibility rates. In this paper, we investigate the components of the more recent decline in ESI coverage by firm size, using data from the MEPS-IC, a large nationally representative survey of employers. We examine changes in offer rates, eligibility rates and take-up rates for coverage, and include a new dimension, the availability of and enrollment in dependent coverage. We investigate how these components changed for employers of different sizes and find that declining coverage rates for small firms were due to declines in both offer and take-up rates while declining rates for large firms were due to declining enrollment in offered coverage. We also find a decrease in the availability of dependent coverage at small employers and a shift towards single coverage across employers of all sizes. Understanding the components of the decline in coverage for small and large firms is important for establishing the baseline for observing the effects of the current economic downturn and the implementation of health insurance reform.
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HOW WILL THE AFFORDABLE CARE ACT CHANGE EMPLOYERS' INCENTIVES TO OFFER INSURANCE?
January 2014
Working Paper Number:
CES-14-02
This study investigates how changes in the economic incentives created by the Affordable Care Act (ACA) will affect the probability that private-sector U.S. employers will offer health insurance. Using the Medical Expenditure Panel Survey Insurance Component for 2008-2010, we predict employers' responses to key ACA provisions. Our simulations predict that overall demand for insurance will rise, driven by workers' desire to avoid the individual mandate penalty and the availability of premium tax credits in exchanges. Our analyses also suggest that the average probability of an establishment offering insurance will decline from .83 to .66 with ACA implementation, although there is considerable variation by firm size, industry and union status.
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Older Workers' Access to Employer-Sponsored Retiree Health Insurance, 2000-2004
April 2007
Working Paper Number:
CES-07-12
Using a multivariate framework, we analyze recent trends in employer provision of retiree health insurance (RHI), eligibility for new retirees, and retiree contribution requirements. We also explore whether local labor market characteristics such as the unemployment rate influence RHI provision. Finally, we examine whether the Medicare Modernization Act (MMA) was associated with diverging trends in RHI access for Medicare-eligible and early retirees. Data come for the Medical Expenditure Panel Survey'Insurance Component (MEPS-IC). We find that, while RHI provision to existing retirees remained stable, eligibility for new retirees declined, and contribution requirements increased between 2000 and 2004. The local labor market had no effect on RHI provision. While early retiree coverage was more common than coverage for Medicare-eligible retirees, we did not find a divergence subsequent to MMA. These results suggest growing financial instability for retirees, both because RHI contribution requirements increased, and because businesses dropped coverage for new retirees.
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NEW EVIDENCE ON EMPLOYER PRICE-SENSITIVITY OF OFFERING HEALTH INSURANCE
January 2014
Working Paper Number:
CES-14-01
Economic incentives such as the preferential tax treatment of premiums and economies of scale encourage employers to provide health insurance through the workplace. The employer's decision to offer health insurance depends on how much workers value insurance relative to wages, and that value is likely to vary, given the composition of the establishment's workforce. Using the 2008-2010 MEPS Insurance Component augmented with information from other data sources, we generate new estimates of employers' price-sensitivity of offering insurance. Our results suggest that employers are sensitive to changes in the tax price of insurance, with very small employers exhibiting the largest price-sensitivity. Employer size, workforce composition, and local labor market conditions also influence the employer's decision to offer insurance. New evidence can inform policy discussions about the implications of broad-based reforms that change marginal tax rates as well as targeted strategies that address the tax-exempt status of premiums.
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Employer Health Benefit Costs and Demand for Part-Time Labor
April 2009
Working Paper Number:
CES-09-08
The link between rising employer costs for health insurance benefits and demand for part-time workers is investigated using non-public data from the Medical Expenditure Panel Survey- Insurance Component (MEPS-IC). The MEPS-IC is a nationally representative, annual establishment survey from the Agency for Healthcare Research and Quality (AHRQ). Pooling the establishment level data from the MEPS-IC from 1996-2004 and matching with the Longitudinal Business Database and supplemental economic data from the Bureau of Labor Statistics, a reduced form model of the percent of total FTE employees working part-time is estimated. This is modeled as a function of the employer health insurance contribution, establishment characteristics, and state-level economic indicators. To account for potential endogeneity, health insurance expenditures are estimated using instrumental variables (IVs). The unit of analysis is establishments that offer health insurance to full-time employees but not part time employees. Conditional on establishments offering health insurance to full-time employees, a 1 percent increase in employer health insurance contributions results in a 3.7 percent increase in part-time employees working at establishments in the U.S.
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Planning Parenthood: The Affordable Care Act Young Adult Provision and Pathways to Fertility
January 2017
Working Paper Number:
CES-17-65
This paper investigates the effect of the Affordable Care Act young adult provision on fertility and related outcomes. The expected effect of the provision on fertility is not clear ex ante. By expanding insurance coverage to young adults, the provision may affect fertility directly through expanded options for obtaining contraceptives as well as through expanded options for obtaining pregnancy-, birth-, and infant-related care, and these may lead to decreased or increased fertility, respectively. In addition, the provision may also affect fertility indirectly through marriage or labor markets, and the direction and magnitude of these effects is difficult to determine. This paper considers the effect of the provision on fertility as well as the contributing channels by applying difference-in-differences-type methods using the 2008-2010 and 2012-2013 American Community Survey, 2006-2009 and 2012-2013 Centers for Disease Control and Prevention abortion surveillance data, and 2006-2010 and 2011-2013 National Survey of Family Growth. Results suggest that the provision is associated with decreases in the likelihood of having given birth and abortion rates and an increase in the likelihood of using long-term hormonal contraceptives.
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Manufacturing Firms' Decisions Regarding Retiree Health Insurance
June 2003
Working Paper Number:
CES-03-14
This study analyzes the firm's decision to offer and contribute to retiree health insurance. We apply a binomial probit model and an interval regression model to analyze the likelihood of offering and the proportion of costs contributed by the firm. Our findings indicate that while firm characteristics affect the probability that a firm offers retiree health insurance, financial performance and alternative insurance options significantly affect the firm's generosity towards its cost. This study expands on previous research by including potentially important policy-related measures to the more limited set of firm and workforce characteristics that have been typically employed.
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Contributions to Health Insurance Premiums: When Does the Employer Pay 100 Percent?
December 2005
Working Paper Number:
CES-05-27
We identify the characteristics of establishments that paid 100 percent of health insurance premiums and the policies they offered from 1997-2001, despite increased premium costs. Analyzing data from the MEPS-IC, we see little change in the percent of establishments that paid the full cost of premiums for employees. Most of these establishments were young, small, singleunits, with a relatively high paid workforce. Plans that were fully paid generally required referrals to see specialists, did not cover pre-existing conditions or outpatient prescriptions, and had the highest out-of-pocket expense limits. These plans also were more likely than plans not fully paid by employers to have had a fee-for-service or exclusive provider arrangement, had the highest premiums, and were less likely to be self-insured.
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Medicare Coverage and Reporting
December 2016
Working Paper Number:
carra-2016-12
Medicare coverage of the older population in the United States is widely recognized as being nearly universal. Recent statistics from the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) indicate that 93 percent of individuals aged 65 and older were covered by Medicare in 2013. Those without Medicare include those who are not eligible for the public health program, though the CPS ASEC estimate may also be impacted by misreporting. Using linked data from the CPS ASEC and Medicare Enrollment Database (i.e., the Medicare administrative data), we estimate the extent to which individuals misreport their Medicare coverage. We focus on those who report having Medicare but are not enrolled (false positives) and those who do not report having Medicare but are enrolled (false negatives). We use regression analyses to evaluate factors associated with both types of misreporting including socioeconomic, demographic, and household characteristics. We then provide estimates of the implied Medicare-covered, insured, and uninsured older population, taking into account misreporting in the CPS ASEC. We find an undercount in the CPS ASEC estimates of the Medicare covered population of 4.5 percent. This misreporting is not random - characteristics associated with misreporting include citizenship status, year of entry, labor force participation, Medicare coverage of others in the household, disability status, and imputation of Medicare responses. When we adjust the CPS ASEC estimates to account for misreporting, Medicare coverage of the population aged 65 and older increases from 93.4 percent to 95.6 percent while the uninsured rate decreases from 1.4 percent to 1.3 percent.
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